Provider Demographics
NPI:1528174745
Name:LABORATORIO CLINICO BRISTOL ANGELL INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO BRISTOL ANGELL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GERENTE
Authorized Official - Prefix:MISS
Authorized Official - First Name:LIZTH MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISTOL ANGELI
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:787-864-0630
Mailing Address - Street 1:22 CALLE BALDORIOTY W
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-5341
Mailing Address - Country:US
Mailing Address - Phone:787-864-0630
Mailing Address - Fax:787-864-8356
Practice Address - Street 1:NUM 22 OESTE AVE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-0630
Practice Address - Fax:787-864-8356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR115291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31226Medicare ID - Type UnspecifiedLABORATORIO